This form is for those members who joined VAP during the offline membership process. You can get your certificate in a new format with the same membership number. Please update your information. If you are unsure of your membership number, don't hesitate to get in touch with your state secretary. This is a free service.

Your Membership Certificate Number

Title -- Select -- Mr. Ms. Mrs. Dr. Vd.

Name

Relation (S/O D/O W/O) -- Select -- S/O D/O W/O

Father/Husband Name

Email

Create Password

Mobile

WhatsApp Number

Gender Select your gender Male Female Other

Date of Birth*

Day Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year

Choose Your Speciality -- Select -- Private Practice Government College Teacher Private College Teacher PG Student Government Medical Officer Private Medical Officer Intern Others (For Non-ayurvedic)

Specify Your Speciality

Permanent Address with Pin Code (Address to be printed on download certificate)

City

Permanent State -- Select State -- Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli and Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Ladakh Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal International

Permanent District -- Select a State First --

Pin / Zip Code

Present Clinic / Institute Address

Present Clinic / Institute Address is same as Permanent Address

Present State -- Select State -- Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli and Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Ladakh Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal International

Present District -- Select a State First --

Degree -- Select -- Graduation PG PhD

Qualification

Graduation

Post Graduation -- Select Subject -- Agad Tantra Ayurveda Samhita And Siddhant Dravyaguna Vigyan Kaumarbhritya Kayachikitsa Manas Roga Panchkarma Prasuti Tantra And Stree Roga Rachana Sareera Ras Shastra And Bhaishajya Kalpana Rog Nidan And Vikriti Vigyan Shareera Kriya Shareera Rachana Shalakya Tantra Shalya Tantra Swastha Vritta

Ph. D

If Any other

Offline Cash Cheque

Attach a profile photo (max size 5 MB)

File size must be less than 5 MB.

Reference Name

Reference Phone Number

Submit Form